Objective To establish a method for HPLC to determine content of acetyl tyrosine in pediatric compound amino acid injection (19AA-Ⅰ).Methods The chromatographic separation was achieved on a Agilent Hypersil ODS column (250 mm ×4.0 mm,5 μm) with Agilent 1200 liquid chromatography system.The mobile phases consisted of 20 mmol/L sodium dihydrogen phosphate solution ( adjusting pH to 2.5 with phosphoric acid)-acetonitrile (90:10) at a flow rate of 1.0 mL/min, the detection wavelength was 210 nm, the column temperature was 25℃.Results Acetyl tyrosine was completely separated from other amino acids.The calibration curves for acetyl tyrosine revealed good linearity in the range of 12.062-120.62μg/mL (r=0.9999).The average recoveries (n=9) of acetyl tyrosine was 100.0%, RSD% (n=9) was 0.9.The limits of quantification (S/N=10) was 0.15μg/mL.Conclusion The methodological validation results indicate that the established method can be applied to quality control of acetyl tyrosine in pediatric compound amino acid injection (19AA-Ⅰ).

OBJECTIVE:To establish a method for the determination of ethanol,acetonitrile,dichloromethane,ethyl acetate, pyridine in vidarabine monophosphate. METHODS:Headspace GC was performed on the column of Agilent DB-624,programmed temperature,inlet temperature was 200 ℃,the detector was flame ionization detector,detecting temperature was 250 ℃,nitrogen was carrier gas,flow rate was 3 ml/min,split ratio was 1∶1,the top bottles equilibrium temperature was 100 ℃,and equilibrium time was 45 min,injection volume was 1 ml. external standard was used for quantitative analysis. RESULTS:The peaks of five re-sidual solvents could be completely separated from the other peaks respectively,The linear rang was 24.7-296.3 μg/ml for ethanol (r=0.999 6)、1.9-23.2 μg/ml for acetonitrile(r=0.999 0),2.8-33.6 μg/ml for dichloromethane(r=0.998 0),24.7-295.9 μg/ml for ethyl acetate(r=0.999 5),1.0-11.9 μg/ml for pyridine(r=0.998 6);RSDs of precision and reproducibility tests were lower than 4.35%;recoveries were 102.4%(RSD=2.0%,n=9)、102.1%(RSD=3.4%,n=9)、105.5%(RSD=4.8%,n=9)、100.3%(RSD=4.8%, n=9)、98.3%(RSD=4.0%,n=9). The minimum quantifation limit was 0.304 4-0.988 0 μg/ml and the minimum detection limit was 0.101 5-0.329 3 μg/ml. CONCLUSIONS:The method is simple,accurate and reproducible,and can be used for the determination of residual solvents in vidarabine monophosphate.

Objective To introduce the clinical application and method of endoscopic harvesting the sural nerve in the carbon dioxide gas cavity. Methods 7 cases with peripheral nerve defect were involved, including 5 men and 2 women. The length of nerve defects ranged from 5 to 8 cm, all the nerve defects were repaired by autogenous sural nerve grafting. The sural nerve were removed from 9 calves in 7 cases. Along the course of the sural nerve in the proximal calf, a transverse 1.0 to 1.5 cm incision was done for endoscope approach, another transverse 0.5 to 1.0 cm incision was done lateral to the sural nerve for operation approach. Using abdominoscope system, the sural nerves were cut and removed smoothly in the cavities which were maintained the gas pressure 10 to 15 mm Hg with carbon dioxide insufflation. All the peripheral nerve defects of 7 cases were repaired as cable graft with harvested sural nerve. Results The length of nerve graft harvested from 30 to 42 cm in 9 calves. It took about 30 minutes to harvest the nerve in each side. There was no abvious injuries found by pathologic inspection. No carbonemia and air embolism occurred on patients during operating time, no complications of hypodermic pneumatosis and hematoma occurred on all cases. All patients followed up from 6 to 10 months, the function recovery of the nerves was good. The muscle power was obtained 2 to 4 grade, the sensation was obtained S3 to S4 grade. The function recovered as fast as the traditional operation of sural nerve transfer. Conclusion The method of endoscopic harvesting the sural nerve in the carbon dioxide gas cavity with minimal incision is easy to perform. Compared with the long longitudinal incision and multiple stair-step incision, the method can get less invasive and traumatic, and good aesthetic results. This technique deserves the doctor application in clinical work.

Objective To explore the strategy of damage control in clinic treatment of severe limb (finger) with multiple injuries.Methods Severe multiple injuries patients with ISS evaluation more than 16 points were chosen for this study.Simple replatations of severed limb(finger) were perfored in 40 patients while their multiple injuries were actively treated.Results Among the 40 cases, all cases survived.1-3 years follow-up showed that the results were excellet in 8, good in 21, middle in 7, and poor in 4, with an excellent or good rate of 72.5 percent.Conclusion Multiple specialties cooperation, early treatment of multiple injuries and experienced microsurgery operation are the keys to improve success rate of replantation of severed limb(linger) with multiple injuries.

Objective To investigate the effect of transitional care on postpartum negative mood for puerpera. Methods One hundred sixty eligible puerperas were recruited between January 2013 and October 2014. By order of hospitalization, participants were randomly assigned into two groups. The control group (80 cases) received routine care. The study group received transitional care which consisted of predischarge assessment, structured home visits and telephone follow-ups, psychological rehabilitation group activities, phone and internet consulting services within six months after discharge. Screenings of predischarge depression and anxiety symptoms of the study group were done by Hospital Anxiety and Depression Scale (HADS). Evaluations of depression and anxiety symptoms of two groups were done by Edinburgh postnatal depression scale (EPDS) and Self-Rating Anxiety Scale(SAS)on postpartum forty-two days and six months. Results There were no differences in demographics, maternal indicators and completion of follow-up between groups (P > 0.05). On postpartum forty-two days, the study group had significantly better depression and anxiety scores (P < 0.05), the depression and anxiety scores of study group were 7.71 ± 2.61and 44.3 ± 6.1, those of control group were 8.31 ± 2.72 and 47.6 ± 5.4. There were no differences in the incidences of depression and anxiety between the two groups (P>0.05). On postpartum six months, the study group had significantly better depression and anxiety scores, less incidences of depression and anxiety than the control group (P<0.05). The depression and anxiety scores of the study
group were 7.13±2.52 and 42.6±6.0, those of control group were 8.87±2.66 and 48.8±5.9. The incidences of depression and anxiety of study group were 6.4%(5/78)and 7.7%(6/78), those of control group were both 26.0%(20/77). Analysis of multiple linear regression suggested that age, education level and family income would affect transitional care intervention on postpartum depression. Conclusions This study established a nurse-led transitional care model which selected the gynecology and obstetrics professional nurse as advanced practice nurse. Results demonstrated that transitional care was effective on improving maternal postpartum depression and anxiety.

Objective To analyze the characteristic of auditory brainstem responses (ABR) evoked by chirp in normal hearing subjects .Methods Fifteen cases (30 ears) with normal hearing young people were recorded ABR by stimulation with two kinds of sounds :chirp and click .The data were compared .Results The response threshold of chirp-ABR were lower than that of click -ABR .The average difference was 8 .59 dB .At 90 dB nHL ,the wave V amplitude yield no significant difference between chirp -ABR and click-ABR .The wave V amplitude had a signifi-cant difference between chirp -ABR and click-ABR at 60 dB nHL .At 90 and 60 dB nHL ,the wave V amplitude of chirp-ABR had not a significant difference .The occurence rate was 40% for the wave I of chirp -ABR ,obvi-ously less than that of click -ABR .At 90 dB nHL ,the wave V latency of chirp -ABR was shorter than that of click-ABR .Conclusion The wave V response threshold of chirp -ABR is less than that of the click -ABR .The chirp-ABR is more advantageous than the click -ABR for assessing hearing threshold .

Remembering medical English terms is the difficult point in learning medical English.Only through learning the rules and characteristics of medical terms can one remember and get command of thousands of medical terms rapidly and effectively.When studying medical English terms,we explored and summarized a series of pithy formula hook memorial method - a pithy formula linked to the affix and etyma was turned into rhyming verse and formed a memory chain after memorizing by hook memory method many times so as to keep the medical terms firmly in the mind rapidly.

The enrollment of international medical students has been expanding.How to improve the quality of medical education is a key point.To explore a better way and method to improve the quality of the medical teaching for foreign students in China,the preliminary experi-ences of teaching of Clinical Diagnostics for foreign students are reviewed.

OBJECTIVETo study the classification and individualized treatment of the terminal phalanx of thumb duplication.

METHODSFrom Apr. 2003 to Dec. 2012, 76 patients with 77 involved thumbs duplication at the level which is distal to the interphalangeal joint were retrospectively studied. Based on the morphology (the nail width and the thumb circumference) and the deviation of the thumb, we classified the terminal phalanx of thumb duplication into 5 types as Type A (no bony connection called floating thumb), Type B(asymmetry and no deviation), Type C(asymmetry and deviation), Type D (symmetry and no deviation) and Type E(symmetry and deviation). Different surgical procedures were selected according to different types. Simple excision of the smaller thumb was adopted for Type A case. Removement of the smaller thumb (usually the radial) and of the collateral ligament of the interphalangeal joint were selected for Type B. Removement of the smaller thumb (usually the radial) and reconstruction of the collateral ligament of the interphalangeal joint, as well as corrective osteotomies at the neck of the proximal phalanx were performed for Type C. The modified Bilhaut-Cloquet procedure with reconstruction of the collateral ligament of the interphalangeal joint were adopted in Type D. The classical Bilhaut-Cloquet procedure, or the modified Bilhaut-Cloquet procedure with reconstruction of the collateral ligament of the interphalangeal joint and corrective osteotomies at the neck of the proximal phalanx were performed in Type E. The results were assessed by an evaluation form for thumb duplication by the Japanese Society for Surgery of the Hand.

RESULTSAccording to our new classification standard, there were 3 cases with Type A duplicated thumbs, 36 with Type B, 13 with Type C, 15 with Type D, 10 with Type E. All the 76 patients underwent the individualized surgical treatment. The patients were followed up for 6-60 months. According to the evaluation form, excellent results were achieved in 66 thumbs, good in 9 thumbs and fair in 2 thumbs.

CONCLUSIONSThe new classification could comprehensively describe the clinical features of the terminal phalanx of congenital thumb duplication. Individualized therapy, including basic and repeated surgical procedure could be adopted for each type with satisfactory results.

Child ; Collateral Ligaments ; surgery ; Finger Phalanges ; surgery ; Humans ; Orthopedic Procedures ; methods ; Osteotomy ; methods ; Polydactyly ; classification ; surgery ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Thumb ; abnormalities

Objective To investigate the possibility and utility of metformin alone or in combination with fosinopril to reduce blood pressure in patients with essential hypertension.Met hods A total of 140 cases of non-diabetic essential hypertension with hyperinsulinemia were recruited and randomly assigned to two groups: a group of 68 treated with metformin 500 mg tid and a group of 72 treated with fosinopril 10 mg qd.The duration of the treatment was 8 weeks.Combination therapy with the two drugs was used after 4 weeks of treatment if needed.If the target goals of systolic blood pressure (SBP) < 140 mm Hg (1 mm Hg =0.133 kPa) and /or diastolic blood pressure (DBP) <90 mm Hg were not attained 4 weeks, combination therapy with two drugs was used in either group in the next 4 weeks.The changes of blood pressure and insulin sensitivity of the two groups were observed before and after treatment.Results (1) After 4 weeks of treatment, SBP in metformin group and fosinopril group decreased by ( 13.0 ± 1.2) mm Hg and (15.4 ± 1.4) mm Hg, and DBP decreased by (9.0 ± 1.0) mm Hg and ( 10.4 ± 1.1 ) mm Hg respectively.After 8 weeks of treatment, SBP in metformin group and fosinopril group decreased by (17.8 ± 1.5) mm Hg and (20.9 ± 1.5) mm Hg, and DBP decreased by (13.2 ±0.9) mm Hg and (15.3 ± 1.1) mm Hg respectively.There was no significant difference in the decline of blood pressure between the two groups (P >0.05).The rates of combination therapy were both 54% in the two groups.(2) Fasting insulin as well as 30 min and 120 min insulin levels after oral glucose tolerance test and insulin area under the curve in the metformin group were significantly reduced after 4 and 8 weeks of treatment as compared with those of baseline(P < 0.05 and P < 0.01 ) .In the fosinopril group, however, they decreased only after 8 weeks treatment (P < 0.05).The insulin action index in the metformin group was higher than that in the fosinopril group after 4 weeks of treatment (P <0.05) ,but there was no significant difference between the two groups after 8 weeks of treatment (P > 0.05).Conclusion Metformin and fosinopril have similar antihypertensive effect and a good synergy in essential hypertension with hyperinsulinemia.